You may submit this application directly to TUSPM by hitting the Submit button found at the bottom of this page. If you prefer, this application may be printed and faxed or mailed to TUSPM (see address information at end of page). Please print legibly.

Submission of MCAT, GRE, or DAT scores is optional.

Please provide the following information:

Session	Winter Program Summer Program
First name
Last name
Current Address
Second line
City
State/Province
Zip/Postal Code
Country
Current daytime phone number
E-mail address
Permanent Address (if different from Current)
Second line
City
State/Province
Zip/Postal Code
Country
Permanent daytime phone number
Gender	M F

Colleges/Universities attended: list in chronological order (beginning with most recent) all
colleges, universities and professional schools attended/attending.

College/University	City/State	From Mo./Yr.	To Mo./Yr.	Major	Degree	Degree Date	Total Credit Hours

Undergraduate G.P.A. (4.0 scale): Please list two digits to right of decimal (i.e., 3.65)
Overall: Science:

Enter N/A below if no Graduate level course work has been completed:
Post Baccalaureate G.P.A. Graduate School G.P.A. Professional School G.P.A.

The following items must accompany this application (or be mailed in with a copy of your application, if you are submitting it via internet). Maximum of one typed page per item. Please include ALL items in the same envelope.

• college transcript or grade report
  
• resume
  
• essay indicating why you are interested in a health care career
  
• a recommendation from a college faculty member indicating your interest and aptitude for science and medicine, in a sealed and signed envelope.
  
• a letter describing your activities and/or work experience that demonstrates your interest and aptitude for working with people (i.e. health care setting, community service, volunteer work, etc.)

*A $100 deposit is required if accepted into the program.  This deposit will be fully refunded upon completion of the program.

Mail to:
Winter (or Summer) Internship Program
Temple University School of Podiatric Medicine
Office of Student Affairs
8th at Race Streets
Philadelphia, PA 19107

or Fax to:
215-627-2815

or submit electronically to Student Affairs: